Uremic tumoral calcinosis of the cervical spine

A 65-year-old man with end-stage renal disease secondary to lupus presented to the emergency department with severe neck pain, progressive bilateral lower extremity weakness and upper motor neuron findings. Weakness had been progressive over the preceding 2 weeks and was quantified as American Spinal Cord Injury Association impairment scale C with a C6 root level. On physical examination, painless periarticular soft tissue masses were identified along the ulnar aspect of his left wrist and left first metatarsophalangeal joint. Corresponding multilobulated calcium depositions and vascular calcification were visible on radiography. Uremic tumoral calcinosis occurs in 0.5%-3% of patients with end-stage renal disease who are undergoing hemodialysis and is the result of metabolic bone disease. Hyperparathyroidism and hyperphosphatemia contribute to ectopic periarticular deposition of calcium phosphate, although the mechanism is poorly understood. Vascular calcification and calciphylaxis can also occur in patients with metabolic bone disease from end-stage renal disease.